NHS England has recently published new guidance for PCNs, which covers the requirements for PCNs in relation to the DES specifications and how the Investment and Impact Fund will work for the 18 months from October.  This week I explore the implications of this guidance for PCNs.

Additional funding for PCN leadership and management support (£43m this year) is announced.  While PCN Clinical Directors certainly need more management support to help them with the role, this funding has to be taken with two important caveats.  First, there is no indication as to whether this funding is recurrent or not, and second there does not appear to be any extension of the additional Clinical Director funding itself (which had been increased for the first 9 months of this year).  So rather than “additional funding” it could probably be more accurately described as a re-badging (and reduction) of funding that PCNs are already currently receiving.

What is certainly good news is the announcement that PCNs will not be expected to deliver all of the additional PCN DES service specifications from 1^st October, as had previously been signalled.  PCNs have to start with two: CVD prevention and diagnosis and tackling neighbourhood health inequalities.  Even these have been given an 18 month implementation timetable, meaning that the requirements for the first six months are not the full specifications.

Alongside this, the guidance announces the requirements for the anticipatory care and personalised care service specifications for 22/23, meaning PCNs are able to prepare for these now.

Of course the question all along has been where the funding for the additional work in each of these specifications is coming from.  What has become clearer with this publication is that the Investment and Impact Framework (IIF) is intended to provide direct funding support (or ‘incentives’ as NHS England like to term it) for the specifications.  Previously just over £50M had been allocated for the indicators in the IIF from April, but now new indicators have been added from 1 October that take the total national investment to the previously promised £150M.

As an aside, I find talking in these national, aggregated figures extremely unhelpful.  I understand it works for politicians and national figures when they are trying to demonstrate they are investing in general practice, but what a PCN needs to understand is exactly what it means for them (or even for an ‘average PCN’).  The original (£50M) IIF funds meant just over £40,000 was available to the average PCN, and this effectively triples that now this year to just over £120,000 for the average PCN.  In 2022/23 the total available increases to £225M, or £180,000 per PCN.

In the revised IIF there are a total of 666 points now available in 21/22 across 19 indicators.  This jump from just 6 indicators at present will need managing by PCNs.  80 of these points are allocated to the CHD specification (i.e. around £14,500 per PCN) and 56 to the health inequalities one in 21/22 (around £10,000 per PCN).  This does stand in contrast to the 222 points allocated to improving access to primary care services (or 166 if you don’t want to double count the health inequalities indicator, although even that indicator is not about tackling health inequalities per se, but rather health inequalities specifically in relation to access to GP services).

This latest guidance highlights that the focus on access to general practice is firmly back on the agenda.  I am not sure it ever really went away, but PCNs took primacy over access in national policy making for a couple of years, but we are certainly seeing it make a comeback now.  NHS England have produced this chart that summarises ‘PCN objectives’ for the next 18 months, and out of nowhere ‘improving patient access’ has appeared as one of the top 5 objectives for PCNs.  At the same time, supporting and sustaining core general practice is notable by its absence from this list.

Guidance had been promised on the transition of commissioning extended access services from CCGs to PCNs in the “summer” of 2021.  This letter states that this will now be available in “autumn”, but the deadline for the transition remains as April 2022.  This guidance was due last year, and has now been put back again, so it is clearly proving difficult to agree.  NHS England is probably stuck between a rock and a hard place with the government demanding more and more in relation to access, and the GPC unwilling to agree that PCNs will deliver more for less.  In the meantime PCNs are expected to have “undertaken good engagement with existing providers”, which in the absence of any guidance or indication of funding levels is something of a nonsense.

So that’s it.  There was always going to be a scaling up of expectations on PCNs, and we are starting to see this now.  It will soon be impossible for PCN CDs to manage PCNs on their own, simply because of the scale of the demands and delivery responsibilities upon each PCN.  For PCNs to work they need to do more than just what NHS England wants them to, as they also need to make a difference to their own member practices.  This latest guidance reinforces the need for PCNs to make sure they have they have clearly set their own priorities (so as not to be simply swamped by the national ones) and have the infrastructure in place to meet the ever-expanding requirements placed upon them.